A threshold injury under the Motor Accident Injuries Act 2017 (NSW) includes a soft tissue injury and a psychological or psychiatric injury that is not a recognised psychiatric illness (adjustment disorder and acute stress disorder are the usual examples; s 1.6 and Motor Accident Guidelines Part 5).
If you’ve developed chronic regional pain syndrome (CRPS) following a road trauma in NSW, understanding your dispute resolution options under the Compulsory Third Party (CTP) scheme is critical. This article explains how the NSW CTP framework applies to CRPS claims, outlines the steps to challenge a decision, and highlights the specific processes available in the Illawarra and South Coast regions.
NSW CTP Rules for CRPS Claims
Under the Motor Accident Injuries Act 2017, CRPS is classified as a 'threshold injury' if it meets the clinical criteria in the Motor Accident Guidelines. SIRA (State Insurance Regulatory Authority) administers CTP claims, and its guidelines state that CRPS may qualify for treatment and care benefits, weekly income payments, or damages depending on the injury’s severity and impact.
However, disputes often arise when claimants believe their CRPS symptoms are not adequately recognized. For example, if your doctor documents persistent pain, nerve damage, or functional limitations that align with SIRA’s threshold injury criteria, you may challenge a decision to limit benefits. Key factors include whether your injury meets the 'spinal nerve-root qualification' outlined in the guidelines.
Practical Steps for Dispute Resolution
- Internal Review: If your claim is denied or limited, request an internal review from SIRA. This allows your case to be reassessed by a different assessor. You must submit this within 28 days of receiving the decision.
- Mediation: If the internal review doesn’t resolve the issue, you can apply for mediation through the NSW Civil and Administrative Tribunal (NCAT). Mediation is voluntary but can help clarify disputes over medical evidence or claim interpretation.
- a Tribunal Application: If mediation fails, you may apply to the NSW Supreme Court or Local Court for a review of the CTP decision. This requires a legal representative and is typically reserved for complex cases involving medical disputes.
Time Limits and When to Seek Advice
Disputes over CRPS claims must be resolved within strict timeframes. For example, you must apply for an internal review within 28 days of the decision. If you’re unsure whether your CRPS meets the threshold injury criteria, seek legal advice promptly. Delays can jeopardize your ability to challenge a decision.
Hypothetical Example
Consider a claimant who suffered a road trauma resulting in CRPS. Their doctor documents neurological signs and functional decline, but SIRA denies treatment benefits, stating the injury doesn’t meet threshold criteria. The claimant can dispute this by: (1) submitting additional medical evidence, (2) requesting an internal review, and (3) escalating to NCAT if unresolved.
Next Steps
Dispute resolution for CRPS claims depends on the timing of your injury, the evidence you’ve gathered, and the specific CTP decision. While SIRA’s guidelines provide a framework, individual cases vary. To request contact about your circumstances, complete the quick, no obligation enquiry form.